A Novel Use of Methylene Blue in the Pediatric ICU

Rutledge, Chrystal; Brown, Brian; Benner, Kim W.; Prabhakaran, Priya; Hayes, Leslie

doi:10.1542/peds.2014-3722

Cited by 19 publications

(21 citation statements)

References 23 publications

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“…This difference in efficacy may possibly originate from variable levels of intrinsic vasopressin and copeptin in children with septic shock, contrary to relative vasopressin deficiency among adult patients [83]. Otherwise, methylene blue was also suggested as another vasoconstrictor for catecholamine-resistant vasodilatory shock [84], which has not been adequately evaluated yet.…”

Section: Hemodynamic Managementmentioning

confidence: 99%

Update on pediatric sepsis: a review

Kawasaki

2017

j intensive care

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BackgroundSepsis is one of the leading causes of mortality among children worldwide. Unfortunately, however, reliable evidence was insufficient in pediatric sepsis and many aspects in clinical practice actually depend on expert consensus and some evidence in adult sepsis. More recent findings have given us deep insights into pediatric sepsis since the publication of the Surviving Sepsis Campaign guidelines 2012.Main textNew knowledge was added regarding the hemodynamic management and the timely use of antimicrobials. Quality improvement initiatives of pediatric “sepsis bundles” were reported to be successful in clinical outcomes by several centers. Moreover, a recently published global epidemiologic study (the SPROUT study) did not only reveal the demographics, therapeutic interventions, and prognostic outcomes but also elucidated the inappropriateness of the current definition of pediatric sepsis.ConclusionsWith these updated knowledge, the management of pediatric sepsis would be expected to make further progress. In addition, it is meaningful that the fundamental data on which future research should be based were established through the SPROUT study.

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Section: Hemodynamic Managementmentioning

confidence: 99%

Update on pediatric sepsis: a review

Kawasaki

2017

j intensive care

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“…Most commonly described hemolysis and hyperbilirubinemia is after MB administration as intra-amniotic or intravenous injections. Thus, the interesting point of our case is the appearance of hemolysis at 8 days after oral MB administration (6,7).…”

Section: Discussionmentioning

confidence: 80%

“…Although MB is an effective antidote to methemoglobinemia due to its reductase activity, it can be an oxidative agent in high doses by producing hydrogen peroxide and also can induce methemoglobinemia and red blood cell hemolysis (4,6,7). Early in-vitro studies demonstrated that oxidative function can be increased in G6PD-deficient RBCs incubated with methylene blue (8).…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic Anemia (Hemolysis) Following the Use of Methylene Blue Powder in Newborn: A Case Report

Taleghani

Afjeh

Jafari

2016

Iran Red Crescent Med J

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Introduction: Methylene blue was first described for the treatment of methemoglobinemia but practical usage of the compound for surgical purpose is common. The aim of this report is to describe a case of hemolysis in neonatal period as a potential hazard of methylene blue toxicity without presence of G6PD deficiency. Case Presentation: In October 2015, a 36-week GA female infant with 2.05 kg weight was delivered by cesarean section with APGAR score of 9/9 from a healthy mother, with common type esophageal atresia. She underwent surgical repair with drainage tube placement on second day of life in our subspecialty referral center, Tehran, Iran. Her blood group type was A+ and her mother was AB+ with no family history of hematologic disease. On fifth day postoperative, 2 mL of methylene blue solution that was prepared by dissolving its powder in the hospital laboratory were fed per oral for confirmation of the integrity of esophagus after repair. 8 days after methylene blue ingestion, we met suddenly the occurrence of severe anemia and hyperbilirubinemia with Hb: 6 gr/dL (postoperative Hb: 15 gr/dL) , retic count: 4.8%, total bill/direct: 20/ 0.3, indirect coombs negative ,G6PD: sufficient, ALT: 30 U/L, and AST: 66U/L. At follow-up 2 months after the initial operation, barium meal showed moderate stricture at the site of anastomosis. Conclusions: We considered two main reasons for hemolysis in our patient. The first explanation is that our patient received 20 mg/kg MB as solution which was nearly 5 -10 times more concentrated than the recommended dose. The second is that the absorption of MB from mediastinal/plural space could be more than expected. Our justification for this event is the anastomosis site stricture at follow-up that was suggestive of Methylene blue leak to mediastinal/plural space on first day after repair. Therefore, paying attention to the preparation of methylene blue solution from its powder is essential. Determination of G6PD status as a risk factor for development of methylene blue toxicity is recommended. However, G6PD with two rechecks was sufficient for our patient.

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“…It is well known for a role in the treatment of methemoglobinemia [8], and cyanide poisoning [9,10]. It is also employed in the management of severe sepsis [11], and hypotension that is refractory to vasopressor agents and intravenous fluids [12]. The dye is also an effective remedy for encephalopathy caused by the alkylating agent ifosfamide [13,14].…”

Section: Introductionmentioning

confidence: 99%

Methylene Blue Protects against Acidified Sodium Taurocholate-Induced Gastric Mucosal Damage

Abdel-Salam

Sleem

Medhat

et al. 2019

ROS

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The effect of methylene blue (MethyB) on the development of gastric mucosal injury caused by orally given acidified sodium taurocholate (80 mM in 2 ml of 0.15 N HCI) in pylorus-ligated rats was studied. MethyB was intraperitoneally given at doses of 20 and 40 mg/kg at time of pylorus-ligation, and animals were euthanized 90 min later, when gastric secretory responses and the number and severity of mucosal lesions were determined. Lipid peroxidation (malondialdehyde), nitric oxide, reduced glutathione (GSH), and paraoxonase-1 (PON-1) activity in gastric homogenates were measured. Gastric mucosal histopathology and histochemical staining for mucopolysaccharides were also done. Results indicated that acidified sodium taurocholate (Na +taurocholate) caused severe gastric lesions. It also increased gastric malondialdehyde by 70% and decreased GSH levels by 36.4% compared with the corresponding control values. Additionally, nitric oxide decreased by 49.3% and PON-1 activity fell by 54.2% in gastric tissue of Na +-taurocholate-treated rats. The administration of MethyB reduced the number and severity of gastric mucosal lesions but had no effect on gastric acid secretion in Na +-taurocholate-treated rats. MethyB resulted in decreased malondialdehyde and increased GSH, nitric oxide, and PON-1 activity in a dose-dependent manner. Na +-taurocholate caused massive sloughing and hemorrhagic erosions of the superficial parts of gastric epithelium, lamina propria, and sloughing of gastric glands. These changes were markedly attenuated by MethyB at 40 mg/kg. MethyB also restored gastric mucus as indicated by the increase in apical epithelial cells positively stained with periodic acid Schiff. These data suggest a protective effect for MethyB against gastric mucosal damage caused by Na +-taurocholate which is likely to be due to decreased oxidative stress.

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A Novel Use of Methylene Blue in the Pediatric ICU

Cited by 19 publications

References 23 publications

Update on pediatric sepsis: a review

Update on pediatric sepsis: a review

Iatrogenic Anemia (Hemolysis) Following the Use of Methylene Blue Powder in Newborn: A Case Report

Methylene Blue Protects against Acidified Sodium Taurocholate-Induced Gastric Mucosal Damage

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